<!DOCTYPE html>
<html>
	{include file="public/header" /}

	<body>
		<div class="layui-form" lay-filter="layuiadmin-form-admin" id="layuiadmin-form-admin" style="padding: 20px 30px 0 0;">

			<div class="layui-form-item">
				<label class="layui-form-label">订单号</label>
				<div class="layui-input-inline">
					<input type="text" name="OrderSn" lay-verify="required" placeholder="请输入用户名" autocomplete="off" class="layui-input" value="{$data.OrderSn}">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label">展期费</label>
				<div class="layui-input-inline">
					<input type="text" name="zhanqifei" lay-verify="required" placeholder="请输入用户名" autocomplete="off" class="layui-input" disabled="true" value="{$data.zhanqifei}">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label">展期天数</label>
				<div class="layui-input-inline">
					<input type="text" name="zhanqi_num" lay-verify="required" placeholder="请输入期数" autocomplete="off" class="layui-input" value="{$data.ApplyDay}" disabled="disabled">
				</div>
			</div>
			<div class="layui-inline">
				<label class="layui-form-label">收款方式</label>
				<div class="layui-input-block">
					<select name="pay">
						<option value="1" selected="selected">微信</option>
						<option value="2">支付宝</option>
						<option value="3">银行卡转账</option>
					</select>
				</div>
			</div>

			<input type="hidden" name="ID" lay-verify="required" placeholder="隐藏域 编辑用户ID" autocomplete="off" class="layui-input" value="{$data.ID}">
			<div class="layui-form-item layui-hide">
				<button class="layui-btn" lay-submit lay-filter="LAY-user-back-submit" id="LAY-user-back-submit">提交</button>
			</div>
		</div>
		
		
		
		
		<!--<script src="../../../layuiadmin/layui/layui.js"></script>-->
		{include file="public/footer" /}
		<script>
			layui.use(['form'], function() {
				var $ = layui.$,
					form = layui.form;
			})
		</script>
	</body>

</html>